fc TJNITED STATES NATV^T
f Medical News Letter
Friday, 26 February 1965
Malpractice and The Service Doctor 1
What Kind of Leadership Approach? 5
FROM THE NOTE BOOK
Availability of Neuropsychiatric Residencies in Naval
ACOG Annual Clinical Meeting 8
American Board of Ob-Gyn 8
Ophthalmic Pathology Course 8
American College of Physicians Annual Meeting 8
Naval Medical Research Reports 8
Palpal Reactions to Caries 9
Effectiveness of Copal Resin Varnish Under Amalgam
Effect of Powered Toothbrushing Plus Inter-Dental
Stimulation Upon Severity of Gingivitis 10
Extradietary Fluoride Supplementation 10
DENTAL SECTION (Cont'd)
Dental X-Ray Exposure of Sites Within the Head
Personnel and Professional Notes
Medical Aspects of Operation Sea Orbit, First Round-
the-World Cruise by Nuclear Powered Surface
After that "Hairy One"
Nursing Seminar on the Acute Coronary Patient
Four U.S. Navy Nurse Corps Officers Receive Purple
Heart Awards in Vietnam 21
Report on New U.S. Naval Dental Training Film 21
Addendum to Article on USNH, Philadelphia, De-
scribing the U.S. Naval Aural Rehabilitation Center 21
Cat Scratch Disease 22
Pediatric Office Bacteriology 22
United States Navy
MEDICAL NEWS LETTER
Friday, 26 February 1965
Rear Admiral Robert B. Brown MC USN
Captain M. W, Arnold MC USN (Ret), Editor
William A. Kline, Managing Editor
Aviation Medicine Captain C. E. Wilbur MC USN
Dental Section Captain C. A, Ostrom DC USN
Occupational Medicine CDR N. E. Rosenwinkel MC USN
Preventive Medicine Captain J. W. Millar MC USN
Radiation Medicine CDR J. H. Schulte MC USN
Reserve Section Captain C. Cummings MC USNR
Submarine Medicine CDR J. H. Schulte MC USN
The U.S. Navy Medical News Letter is basically an
official Medical Department publication inviting the
attention of officers of the Medical Department of the
Regular Navy and Naval Reserve to timely up-to-date
items of official and professional interest relative to
medicine, dentistry, and allied sciences. The amount
of information used is only that necessary to inform
adequately officers of the Medical Department of the
existence and source of such information. The items
used are neither intended to be, nor are they, sus-
ceptible to use by any officer as a substitute for any
item or article in its original form. All readers of the
News Letter are urged to obtain the original of those
items of particular interest to the individual.
Change of Address
Please forward changes of address for the News Letter
to: Commanding Officer, U.S. Naval Medical School,
National Naval Medical Center, Bethesda, Maryland
20014, giving full name, rank, corps, and old and new
FRONT COVER: Aerial view of the U.S. Naval Hospital, Camp Lejeune, N.C. Commissioned on 1 May 1943
at a construction cost of $7,500,000, this hospital is a self-contained command under management and technical
control of the Bureau of Medicine and Surgery, Navy Department. Coordination control is exercised by the
Commandant, Fifth Naval District and military control by the Commanding General, Marine Corps Base, Camp
Lejeune, N.C. The mission is hospitalization support for military personnel and dependents of the Marine Corps
Base; Force Troops, Second Marine Division; Marine Corps Air Facility, New River; and Marine Corps Air
Station, Cherry Point, N.C.
Authorized operating bed capacity is 475, with an expanded capacity of 1,173 beds. The peak patient load
during WW II was 2087^during Korean Conflict, 1,865. Since commissioning, the hospital has admitted approx-
imately 87,000 military patients and 77,500 others. There has been a total of 45,000 births recorded. Fully
accredited by the Joint Commission on Accreditation of Hospitals, specialist clinical services now include General
Medicine, General Surgery, Orthopaedic Surgery, Obstetrics and Gynecology, Pediatrics, Ophthalmology, Urology,
Radiology, Pathology, Otorhinolaryngology, Neuropsychiatry, Dentistry, Pharmacy and Physiotherapy.— (From
the hospital's 20th Anniversary Brochure, May 1963. Commanding Officer: Capt. Frank T. Norris, MC, USN.)
The issuance of this publication approved by the Secretary of the Navy on 4 May 1964.
U.S. NAVY MEDICAL NEWS LETTER
MALPRACTICE AND THE SERVICE DOCTOR
LCOL Raymond Coward JAGC USA.'"
United States Armed Forces Medical Journal IX(2): 232-240, February 1958.
The FTCA has no application with respect to claims
arising in a foreign country and could not be the basis
for a claim against a service doctor or the United States
as a result of medical treatment the doctor rendered
abroad. Also, the United States has not waived its sov-
ereign immunity that prevents it from being sued in
foreign courts. The Foreign Claims Act of 1942 3= per-
mits claims against the United States by an inhabitant
of the country in which the claim arose, and this Act
has been implemented by Army Regulations, 32 but pro-
cedures for handling claims by inhabitants of foreign
countries would, for the most part, be inapplicable to
the problems under discussion, as we are primarily con-
sidering claims on the part of military personnel, civil-
ian employees, or their dependents.
Treaty arrangements between the United States and
a foreign country also have a bearing on a claim arising
in any particular country. In general such arrangements
follow the pattern as set forth in Article VIII, NATO
Status of Forces Agreement." Other similar treaty pro-
visions are contained in the Japanese Administrative
Agreement' 5 and the Bonn Conventions with Germany.'"
Under such treaty provisions, claims arising out of the
performance of official duties are processed and adjudi-
cated by the foreign or receiving state according to its
laws and procedures. Only when the claim arises out
of a nonofficial act would it be processed under the
previously named Federal statutes and regulations. In
each of the treaties there is a provision that precludes
recovery from the individual wrongdoer in a foreign
court if his act was in the performance of official duties.
The degree of protection an individual has from suit in
a local foreign court depends upon the agreement, or
lack of agreement, between the United States and the
Thus, it appears that as a result of treaty arrange-
ments, and a reluctance on the part of United States
citizens to litigate in foreign courts, there is little likeli-
hood that a service doctor will be sued in a foreign
* Colonel Coward
now retired from the Army and lives at Searcy,
The Federal Civil Defense Act," which became effec-
tive on 12 January 1951, in effect suspends the cover-
age afforded under the provisions of the Federal Tort
Claims Act in the event of a national emergency, as will
be seen from section 2294 thereof which provides:
The Federal Government shall not be liable for any
damage to property or for any death or personal injury
occurring directly or indirectly as a result of the exer-
cise or performance of, or failure to exercise or per-
form, any function or duty, by any Federal agency or
employee of the Government, in carrying out the pro-
visions of this title during the period of such emergency.
Nothing contained in this section shall affect the right
of any person to receive any benefit or compensation to
which he might otherwise be entitled under the Federal
Employees' Compensation Act, as amended.
It will be seen that this statute excuses the Govern-
ment from liability for damages or injuries occurring
as a result of the performance of, or failure to perform,
any function or duty by any Federal agency or em-
ployee of the Government in carrying out its provisions
in an emergency, and the United States has not waived
its immunity from suit under such circumstances.
There are relatively few insurance companies that
will write malpractice or medical professional liability
insurance and the rate is substantially higher for a
doctor who desires surgical, x-ray, or shock treatment
coverage than for the general practitioner. These dis-
tinctions apply equally to military doctors, but rates are
generally lower for them than for civilian doctors.
Presumably the main reason for this is the knowledge
that Government lawyers will defend suits brought
under the Federal Tort Claims Act.
The policy followed by The Surgeon General as to
whether an Army doctor or nurse should carry mal-
practice insurance is that each one should decide this
matter individually. The question arises occasionally
whether the Department of the Army should pay mal-
U.S. NAVY MEDICAL NEWS LETTER
practice insurance premiums to protect Army doctors;
however, there is no known authority in existing per-
manent law or current appropriation acts that would
permit the Army to pay such premiums out of funds
appropriated by Congress. Further, if legislation should
be proposed which would authorize the Army to pay
malpractice insurance premiums, it appears likely that
the Department of the Army would oppose its enact-
ment. This is indicated by the position taken in 1955
with respect to H.R. 10577, 84th Congress, a bill "To
provide for the procurement by the Government jf in-
surance against risk to civilian personnel of liability for
personal injury or death, or for property damage, aris-
ing from the operation of motor vehicles in the per-
formance of official Government duties, and for other
purposes." In opposing this bill the Department of the
The bill would provide a limited amount of liability
insurance or alternatively virtually complete indemni-
fication for a limited class of Federal employees subject
only to the provision that in any such case the act of
an employee forming the basis for such action must be
found to be 'in the performance of his official duties.'
It contains no standard of conduct for the officers and
employees to be protected and no standard of responsi-
bility for potential insurers. . . The Federal Tort Claims
Act, supra, now provides ample protection to third
parties damaged or injured by the actions or omissions
of Government workers acting within the scope of their
The Department of the Army also stated that gov-
ernment procurement of commercial insurance would
be unusual. It added, "It long has been the settled
policy of the United States to assume its own risks (35
Comp. Gen. 391, 392)."
PATIENT'S RIGHT TO PRIVACY
There is a growing tendency to recognize the right of
privacy as enforceable by an action in tort. 38 Under
certain circumstances, tort action could be brought
against a physician for violation of the patient's right
to privacy, on the basis that "A person who unreason-
ably and seriously interferes with another's interest in
not having his affairs known or his likeness exhibited
to the public is liable to the other." 3 "
The information that the doctor learns about the
patient in the course of examination and treatment is in
the nature of privileged communication and should not
be revealed to unauthorized individuals without the
specific consent of the patient. When a patient disrobes
for any type of medical procedure, he does so for the
professional benefit of the doctor, and unless he gives
consent there should not be admitted either medical or
nonmedical personnel who are not essential to the
carrying out of the particular medical procedure.™ To
do otherwise is to violate the patient's right to privacy.
Written consent should be obtained in order to take
pictures of the patient, and the pictures should be taken
in such manner that the later use of them will not re-
veal his identity unless he has authorized in writing that
it be revealed. The mere taking of pictures that are not
authorized by the patient may constitute a cause of
action against the doctor, even if they are never pub-
lished. 4 " This is true even though the pictures are for
a worthy purpose such as advancing medical science.
The performance of an unnecessary and unauthorized
autopsy may subject the service doctor to a suit for
damages by the next of kin or legal representatives of
the deceased. The doctor might also be prosecuted for
the violation of a criminal statute. The performance of
an autopsy on the remains of a person who dies while
serving on active duty in the military service is author-
ized under the conditions set forth in Army Regulations
(1) Deceased military personnel. An autopsy will
be performed on the remains of any person who dies
in the military service while serving on active duty
when the commander or the surgeon of an installa-
tion or command deems such procedure necessary in
order to determine the true cause of death, and to
secure information for the completion of military
The same regulation requires written consent from the
next of kin before performing an autopsy on a retired
person or civilian who dies in a medical treatment
facility or on a military installation. It also provides
that an opinion defining "next of kin" should be ob-
tained from the local judge advocate for the jurisdiction
in which the installation is located. With respect to the
performance of an autopsy on a civilian, the consent of
the husband or wife or next of kin of the deceased is a
prerequisite to the performance of an autopsy, unless
the autopsy is performed, in accordance with the law,
by or at the direction of the coroner or other authorized
The wrongful dissection of a dead body is regarded
as a willful and intentional wrong against the person
entitled to the possession and control of the body for
burial, and a recovery may be had for the mental
anguish resulting from such a mutilation. The unau-
thorized dissection is an interference with a legal right;
the right to have immediate possession of the body in its
condition at the time of death, and control for burial.
A petition or complaint that alleges the right to a body,
a refusal to deliver up the body on demand, and the
performance of an unauthorized and wrongful autopsy
thereon while it is withheld, states a cause of action.
Further statutes in a number of states makes it a crime
to perform an unauthorized autopsy. 43
U.S. NAVY MEDICAL NEWS LETTER
TRENDS IN MALPRACTICE CASES
In recent years the public has become more informed
concerning medical professional liability, and this may
result in more claims against physicians and surgeons.
The nature of the practice and procedures involved in
some specialties make the doctors practicing in such
specialties more likely to be sued. Based on the amounts
recovered in some recent cases, larger claims may be
expected to be made in the future.
The Law Department, American Medical Associa-
tion,' 1 made an analysis of 605 medical professional
liability decisions reported in the United States from
1935 through 1955. The study included all published
decisions regardless of the level of the court involved.
Of the 605 cases, which involved 782 doctors, the great-
est number had to do with surgical procedures. The
next largest number concerned nonsurgical treatment
and involved such incidents as breaking a hypodermic
needle in giving an injection, prescribing an unofficial
drug, or being negligent in removing a foreign body
from the eye. Treatment of fractures and of burns
also ranked high in the list of causes for claims.
THE DOCTOR IN COURT
There are numerous ways, some voluntary and others
involuntary, in which a doctor may come before the
Court in connection with his medical knowledge and
practice. He may receive a subpoena to appear as
witness for either party in a case about which he has
personal knowledge, he may appear as an expert wit-
ness at the request of one of the parties to the suit,
he may be suing a patient or employer, or he himself
may be sued. In the latter case, the suit may be for
breach of contract, for malpractice in rendering medical
care, for assault and battery, for false imprisonment
(where undue restraint of a patient is used), or for
loss or damage to the property of a patient.
Questions the Court Considers
There are certain basic questions the Court must
consider in an effort to determine liability in any case
of negligence or malpractice. Some of the more im-
portant questions are:
1. Was there a duty on the part of defendant?
2. Was there an injury, with resulting damages, to
3. Was the injury due to negligent action?
4. Did the injury result directly from the negligent
5. Did the doctor commit the negligent action or
did he negligently omit to do something?
6. Does the doctrine of res ipsa loquitur apply under
the particular circumstances?
7. What would a reasonable, prudent doctor have
done under similar circumstances?
In seeking an answer to the last question the problem
would arise as to what standards should be applied as
to the reasonableness of the medical procedure used
in the particular case. The practice of medicine re-
quires the exercise of judgment based on knowledge.
The question at issue in a negligence case is whether
proper judgment was exercised. The doctor is required
to meet the level of professional community practice, in
his own specialty, and not the level or skill of training
possessed by the isolated or unusual practitioner.
The Doctor as a Witness
Before a doctor appears as a witness in a case he
should assure himself that he is thoroughly familiar
with the medical history and all clinical records of the
case in issue. In a case involving a specialty or expert
knowledge, he should review and establish firmly in
his mind the medical principles that are recognized and
accepted in the medical profession. In complicated
cases he should take to court with him published medi-
cal authorities to be cited in his testimony in support of
his position. He may anticipate that he will be rigorous-
ly cross-examined by opposing counsel as to the testi-
mony he gives on direct-examination. A lawyer is
trained to advocate the cause he represents. He seeks
to make the most of any weak points which may appear
in the testimony of witnesses on the opposing side of the
case. The doctor should understand this and be pre-
pared to meet it when he goes into court, rather than
to indicate by his manner that he feels a reflection is
being made upon his professional integrity.
It is important for the medical witness to take his
time in responding to questions and to enunciate his
answer clearly and distinctly. He should avoid long,
complicated, technical answers to questions, and should
speak in plain, understandable layman's language so
that the judge and jury will better understand his testi-
mony. The credibility of the witness, or the extent to
which the Court and jury may believe his testimony,
is very important in a law suit. It has a bearing when
the Court instructs the jury on the evidence applicable
to the case and the jury weighs the evidence by com-
paring the testimony given on one side with that pre-
sented by the opposing party.
Although it is understandable that the trend in mal-
practice claims may cause the doctor concern, he must
have the courage to act in line with his convictions as
to what is best for the patient, using advanced methods
of diagnosis and treatment where indicated, even though
they involve certain risks. In doing this, there are
certain standards or safeguards that, if observed by
the practicing physician or surgeon, may avoid or at
least reduce the number of medical professional liability
U.S. NAVY MEDICAL NEWS LETTER
The following are suggested ways in which the doctor
may reduce the likelihood of suit without jeopardizing
the welfare of his patient:
1. Avoid careless remarks about the medical treat-
ment the patierit may have received previously from
2. Keep thorough, accurate, and complete medical
records. These should include case history as well as
3. Make thorough examinations of the patient, in-
cluding all necessary laboratory tests, roentgenograms,
et cetera, and record the results in the patient's medical
4. Obtain the confidence of the patient, establish
rapport with him, and in general, improve the doctor-
patient relationship as well as the relationship with the
5. Do not experiment with unproven medicines, pro-
cedures, or technics, but adhere to proven and ac-
cepted medical principles and practices.
6. Do not guarantee cures or fixed degrees of im-
provement as a result of following certain prescribed
7. Explain the risks in surgical or medical procedures
proposed, so that the patient understands the situation.
8. Obtain the written consent of the patient and the
next of kin, in appropriate cases, keeping in mind that
for the consent to be valid there must be a full explana-
tion of the procedures and the risks involved.
9. In dealing with a patient with a mental illness,
obtain the written consent of the next of kin if at all
practicable, even though written consent of the patient
is granted, as the patient's mental capacity to give valid
consent may be put in issue at a later date. The ad-
visability of having such a patient examined by more
than one doctor also should be considered. This will
afford the doctor better protection, particularly in a
case where restraint is used, as he may later be charged
with false imprisonment.
10. Beware of the dangers involved in diagnosis and
prescription by telephone, without seeing or examining
Malpractice or medica! professional liability claims
are recognized throughout the United States. The doctor
in government service is less likely to be sued in his
individual capacity than a doctor in private practice,
because of the protection afforded him by the Federal
Tort Claims Act and other Federal laws and regulations.
If the service doctor is sued in a state court for acts
performed in a service hospital within the scope of his
employment or in connection with his official duties,
he may have the case removed to a Federal court for
trial. Under procedures outlined in published Army
Regulations, the Army doctor may also make arrange-
ments for the United States Attorney to defend him
along with the Government. As a result, the rates for
medical professional liability insurance are considerably
lower for doctors in the Federal service than for those
in private practice. The Surgeon General, Department
of the Army, follows the policy of leaving it to each
Army doctor to decide as to whether he should carry
insurance. There is no current authority for payment
of insurance premiums out of funds appropriated by
Congress, and it is the policy of the United States to
assume its own risks.
The patient's welfare should not be jeopardized
through a reluctance on the part of the doctor to
prescribe and render necessary medical treatment in an
effort to protect himself from a possible malpractice
claim, but there are safeguards that, if followed, will
greatly reduce the likelihood of malpractice claims.
Black's Law Dictionary. 4th Edition, p. 1111, citing Gregory v.
Mclnnis, 140 S.C. 52; 134 S.E. 527, 529.
Rodgers v. Kline, 56 Miss. 816, 31 Am. Rep. 389; Hibbard v.
Thompson, 109 Mass. 288; Napier v. Greenzweig, C.C.A.N.Y.,
256 F. 196, 197.
Black's Law Dictionary. 4th Edition, p. 1184, citing Schneeweisz
v. Illinois Central R. Co., 196 111. App. 248, 253, et al.
Black's Law Dictionary. 4th edition, p. 1660, citing Coleman v.
California Yearly Meeting of Friend's Church, 27 Cal.App.2d 579,
81 P. 2d 469, 470.
City of Mobile vs. McCIure, 221 Ala. 51, 127 So. 832, 835.
Black's Law Dictionary, 4th edition, p. 917, citing Cross vs. Pas-
sumpsic Fiber Leather Co., 90 Vt. 397, 98 A. 1010, 1014; Joyce
v. Missouri & Kansas Telephone Co., Mo. App., 211 S.W. 900,
146 P (2) 982 CDist. Ct, of App. 2nd Dist. Dir. 3, Cal. 1944)
affirmed 25 Cal. (2) 486, 154 P (2) 687 (Sup. Ct. of Cal. 1944).
28 U.S.C. 2671, et seq., (1946).
Army Regulations: AR 25-70.
57 Stat. 372, 1943.
Army Regulations: AR 25-25,
50 U.S.C. 738; 28 USC. 2674.
Army Regulations: AR 27-5.
28 U.S.C. 2676.
28 U.S.C. 2671.
E.D. Ark., 123 F. Supp. 906.
D.C., Md„ 93 F. Supp. 567.
225 F. 2d 705.
171 F. 2d 365, cert, denied 337 U.S. 919.
103 F. Supp. 543, affirmed 195 F. 2d 494.
181 F. 2d 723.
346 U.S. 15.
350 U.S. 61.
350 U.S. 907, affirming D.C. Cir., 221 F. 2d 62.
340 U.S. 135 (1950).
178 F. 2d 518, affirming D.C. Mi, 77 F. Supp. 706.
10 Cir., 178 F. 2d 1.
Parr v. U.S., D.C, Kan,, 78 F. Supp. 693, affirmed 172 F. 2d
63 Stat. 861, 5 U.S.C.A. 757(b); Johansen v. U.S., 343 U.S. 427.
Footnote 17, supra.
Public Law 569, 84th Congress, 7 June 1957, 70 Stat. 250.
31 U.S.C. 224d-224i.
Army Regulations: AR 25-90.
TIAS 2846, 19 June 1952.
TtAS 2492, 28 February 1952, and TIAS 2783, 23 March 1953.
Finance Convention as amended by Schedule HI to the Paris
Protocol, 5 May 1955.
50 U.S.C, app. 2294 (1950).
Melvin v. Reid (Cal.), 297 Pac. 91; Schuyler v. Curtis, 147 N.Y.
434; and sec. 138 A. L. R. 22.,
Restat, of Law of Torts, 4.
Patient's right to privacy. (Medicine and Law section) JAMA
165: 167-168, Sept. 14, 1957.
Army Regulations: AR 40-200, paragraph 13.
Doctor and Patient and the Law by Louis J. Regan, 3d edition,
pages 86-87. McPosey v. Sisters of the Sorrowful Mother, et al.
(Okla.) 57 Pac. (2d) 617; Morrow v. Cline (N.C.)., 190 S.E.
207; Liberty Mutual Ins. Co. v. Lipscomb (Ga.), 192 S.E. 56.
Court decisions — medical professional liability. (Medicine and
Law section) JAMA 164: 1349-1357, July 20, 1957.
U.S. NAVY MEDICAL NEWS LETTER
WHAT KIND OF LEADERSHIP APPROACH?
LT Frederick F. Nowak MSC USN ^Instructor in Personnel Records and Personnel
Management, U.S. Naval School of Hospital Administration, National Naval Medical
Center, Bethesda, Maryland 20014.
In the Medical News Letter, Volume 43, Number 4
of 21 February 1964, there appeared an article entitled
"Leadership Concept: Hard Versus Soft Management."
This article is reproduced below.
"The difference between the good leader, manager or supervisor
and the run-of-the-mill one is that the good leader makes things
happen while the other allows things to happen. This is frequently
referred to as the difference between the traditional, military or
"hard" management and "soft" management. In "hard" manage-
ment the leader knows what he wants to have happen and what
needs to be done to accomplish this mission. In "soft" management
the leader backs off from responsibility and merely allows things to
happen. However, there is only one kind of leadership — that conduct
which induces followership and aids in accomplishment of mission.
It has to be adapted to the situation. On occasion it may be driving
— a kick in the seat; other times it may be pulling — inquiring into
and tapping a person's mental resources. Whichever it is, it requires
knowledge of human behavior to promote outstanding performance.
At first blush, the article appeared to be speaking of
only two types of leadership, autocratic (hard) and
laissez-faire (soft). Upon re-reading the article, it is
evident that the more modern concept of leadership is
included and deserves further amplification.
Before presenting any personal thoughts concerning
the modern concept of leadership, I would like to state
that although the concept of laissez-faire does in fact
exist, and unfortunately so, I would rather not consider
this to be a form of leadership. It isn't leadership, it
is nothing. When the thought of leadership comes to
mind, a stimulus also comes in mind. If laissez-faire
is to be considered a stimulus, it is a negative one.
Such negativism is not the type of leadership the Navy
The text on Naval Leadership states that "the best
methods of naval leadership must simultaneously exist
in two dissimilar and opposite forms." 1 These two
forms, authoritarian and democratic, exist and are in-
cluded in and commonly known as the Theory of Bi-
Why must two dissimilar methods of naval leadership
exist simultaneously? There is a definite requirement
* Forwarded to the Medical News Letter by CDR E. L. Van Land-
ingham Jr., MSC USN-Commanding Officer, U.S. Naval School of
Hospital Administration, NNMC, Bethesda, Md,
1 Malcolm E. Wolfe, Commander, U.S. Navy, et a], Naval Leader-
ship (2nd ed, U.S. Naval Institute, Annapolis, Md., 1959), pp.
in the Navy for an unquestioning response to authority
even though this response may at times be unpalatable.
A man's democratic rights do suffer under this approach
but the need cannot be denied. 3
It has been determined that a higher form of motiva-
tion can be attained by using the democratic approach
or what has been called by various authors the partici-
pative approach to leadership. 4 I am certain that the
need for a higher form of motivation is the desire of
all leaders, a motivation that permits the individual to
gain satisfaction from the challenge and accomplish-
ment of the task before him.
The problem that exists is to fuse the two dissimilar
forms of leadership. Missions and objectives must be
accomplished — goals must be set and met. One of our
jobs as leaders is to set and accomplish these goals.
Another one of our jobs is to satisfy the needs of our
followers. It then seems necessary that we motivate
our followers in such a manner that their needs are
satisfied through the attainment of the goal. Research
has indicated that one method of providing such satis-
faction of needs even though directed toward the
established goal is through the use of the democratic,
participative, or permissive (not to be confused with
laissez-faire) leadership. Get the followers' ego-involved
so that they will have a direct interest in the accom-
plishment of the goal and achieve satisfaction while
working toward and accomplishing this goal.
I believe that, for the sake of discussion, delegation
may be included in participation. There are many
reasons why leaders will not permit participation. Some
of these reasons are: the feeling that one can do the
job much better than others; participation takes too
long; a lack of decisiveness in the matter; a concern
that the subordinates may do a better job, thereby,
endangering one's position; a lack of ability to direct
others; a lack of confidence in subordinates; a lack of
proper feed-back for control purposes; and the cal-
culated risk of taking a chance. This list is not intended
to be all inclusive. One of the many responsibilities of
U.S. NAVY MEDICAL NEWS LETTER
the leader is to develop his subordinates. Participation
is an excellent means for development. This is just
another reason for the use of the democratic or partici-
pative form of leadership.
There are many reasons, and very good ones, for
the use of the authoritarian form of leadership. The
need for a positive structure and a single direction of
purpose is an economic and military necessity. Such a
need is not denied under certain circumstances but the
need for participation also cannot be denied.
Below is a graphic presentation of the two dissimilar
methods of leadership with graduations and combina-
tions of each." This portrayal has been slightly modified
in order to make it more leader-oriented.
USE OF AUTHORITY
Area of Freedom of Action
afforded followers (Entropy)
The graphic portrayal, as you may have noticed, does
not permit complete freedom of action on the part of
the followers. The leader is still in authority, defining
the limits within which the followers may have freedom
of action. At the right of the portrayal the ingredients
of control and leadership necessary for the accomplish-
ment of the task are still present but to a much lesser
degree than indicated to the left of the diagram. The
same concept applies to the extreme left which indicates
that authority is not absolute. Authority, like freedom,
is never without limitations.
Deciding on the Leadership Pattern
It is not possible to state which leadership pattern is
to be followed. There are too many variables involved
in the ultimate determination. Generally speaking, these
variables may be classified under the general headings
of the leader, the followers, and the situation that exists
at a particular moment."
The Leader. A leader's behavior under any circum-
stances is in part influenced by his own personality.
Over the years an individual develops a value system of
his own and he will act in such a manner as to best
maintain his system of values. Perhaps he is naturally
dominant and is comfortable in the leadership role only
when he is acting in an autocratic manner. He may not
be comfortable having others make decisions for which
5. Robert Tannenbaum an<f Warren H. Schmidt, "How to Choose a
Leadership Pattern," Harvard Business Review, Vol, 36, No. 2,
March-April IMS, pp. 95-101.
he is ultimately responsible. There may be a feeling
of uncertainty because of his knowledge of and confi-
dence in his subordinates.
The Follower. Some followers have a definite need
for freedom and independence to make decisions;
whereas, others require and desire a more autocratic
leadership. Not all followers are capable of assuming
the responsibility of decision-making, possibly because
of the lack of necessary knowledge and experience to
deal with problems of a particular nature. Permitting
a man to make a decision when he has been oriented in
an autocratic environment may be quite traumatic. The
same trauma may appear when one who has had free-
dom and independence in decision-making is put into a
very structured, directive, and autocratic environment.
The Situation. The type of leadership demonstrated
is also influenced by the type of organization, the lead-
ership approach practiced by the immediate superiors,
the nature of the group to be led, the nature of the
problem, and the constantly demanding factor of time.
The Navy is basically an autocratic organization.
Autocratic leadership is under many circumstances de-
sired, required, and condoned. A leader has a tendency
to act in a manner which is expected by the organiza-
tion. Tied in closely with the organization is the leader-
ship behavior exhibited by the immediate superior. If
the immediate superior is autocratic, there is a tendency
for the follower of that superior officer to act in the
same manner. The inverse is also true if the superior
is a democratic-type leader.
U.S. NAVY MEDICAL NEWS LETTER
The effectiveness of the group is also a variable that
influences the leadership pattern. A willing, cohesive
group that has the ability to handle problems effectively
can be given more latitude than a less willing, less
cohesive, and less capable group. The latter group
would require more direction than the former.
The group acceptance of the goal is another variable.
The group that accepts the goal as their own may re-
quire much less supervision than the group that is dis-
interested in and does not accept the goal as their own.
The problem itself and the time factor involved may
determine the amount of freedom permitted. Some
problems may require immediate and decisive action —
there is no time for a group conference. Others are not
so urgent and there is opportunity for participation by
the group. Also, there are certain problems which, of
necessity, must be resolved by the leader alone. In
such cases, decision-making cannot be shared with the
These are some of the variables that are working
interdependently which may determine the type of
leadership pattern to be followed. What kind of leader-
ship approach is the best one? Since a higher form of
motivation can normally be gained by the involvement
of personnel and the satisfactions that can be derived
from this involvement, it would appear that the best
leadership approach would be one which is situated on
the right of the continuum of the graphic portrayal.
The prevailing variables would dictate when it would be
necessary to move to the left, the more autocratic form
of leadership. Such movement might be interpreted by
some as a lack of consistency in leadership behavior;
however, it must be realized that different situations
will, of necessity, call for various forms of leadership.
A good leader must be flexible enough to move on the
continuum but he must also establish for himself a
general pattern of leadership behavior.
'ROM THE NOTE BOOK
AVAILABILITY OF NEUROPSYCHIATRY
RESIDENCIES IN NAVAL HOSPITALS
It is the intention of this Branch to apprise inter-
ested individuals of the availability of a limited number
of vacancies in the fully approved Navy psychiatric
residency training program. Each year there are only
nine openings for Navy psychiatrists beginning at the
first year level. The Navy hospitals which have resi-
dency training programs in psychiatry are Bethesda,
Maryland; Oakland, California; and Philadelphia, Penn-
Prospective residents frequently ask the question
whether any Naval hospital can offer completely satis-
factory residency training within its own walls and at
the same time meet the requirements now emphasized
by the review committees of the various national ap-
proving and accrediting bodies. The same question
could be asked of any hospital. The Navy's psychiatric
residency training program, as necessary, utilizes addi-
tional psychiatric facilities to round out the training
program. State psychiatric hospitals are used for gain-
ing full time experience with chronic hospitalized
psychotic patients. Full time assignments are also made,
to gain experience, in neurology, in psychiatric out-
patient clinics and in child guidance clinics. Extensive
use is also made of civilian consultants who conduct
seminars and supervise long term therapy cases. The
experience gained in the Navy hospitals covers inpatient
and outpatient psychiatry with the entire diagnostic
category being covered. Both male and female patients
of all ages are seen for evaluation and treatment as in-
dicated. The types of therapy taught and utilized en-
compass all that are available; for example, individual
and group psychotherapy, and drug, somatic, group
activities, occupational and milieu therapies. In addi-
tion, each residency hospital is located in a metropolitan
area which has available many psychiatric lectures,
short courses and medical schools with excellent psychi-
atric departments. Thus, the availability of academic
exposure to psychiatric matters is extensive. The Neuro-
psychiatric Program is further backed up by relevant
research programs of considerable variety.
The Surgeon General's Consultant Panel in Neuro-
psychiatry is composed of the following clinical mem-
bers. These members are a ready source of assistance
and guidance in dealing with all facets of Navy neuro-
Francis J. Braceland, M.D,
The Institute of Living
200 Retreat Avenue
Hartford 2, Connecticut
Howard P. Rome, M.D.
Head, Psychiatry Section
(and President-Elect of the
Ewald W. Busse, M.D.
Chairman, Department of
Duke University Medical
Durham, North Carolina
Augustus S. Rose, M.D.
Professor of Medicine
Division of Neurology
School of Medicine
The Center for the Health
Los Angeles, Calif. 90024
U.S. NAVY MEDICAL NEWS LETTER
Cecil L. Wittson, M.D.
Dean, College of Medicine, and
Chairman, Department of Neurology and Psychiatry
University of Nebraska
College of Medicine
602 South 44th Avenue
Omaha 5, Nebraska
A copy of a. recent Navy NP Newsletter can be ob-
tained by writing to this office. This generally reports
what was accomplished this past fiscal year and part
of what is planned for the coming year and will give
you further details regarding the scope of Navy psy-
chiatry, including some of the current NP research
Applications for residency training are reviewed by
the Surgeon General's Advisory Board which selects
residents for training. Although most residencies start
in July of each year, for some years residents have been
started in psychiatry at various times of the year vary-
ing with available vacancies at individual hospitals
which result from completion of residency training by
other individuals. Inquiry for further details can be
made directly to this office. We invite those interested
to write promptly to:
Neuropsychiatry Branch (Code 313)
Bureau of Medicine and Surgery
Washington, D.C. 20390
ACOG ANNUAL CLINICAL MEETING
The annual Clinical Meeting of the American Col-
lege of Obstetricians and Gynecologists will be held in
San Francisco, California, 5-8 April 1965. A special
air lift to provide transportation between Andrews Air
Force Base and the U.S. Naval Air Station, Alameda,
California, has been confirmed with the following
Depart Andrews Air Force Base 0800, 4 April 1965
Depart NAS Alameda, California 0800, 9 April 1965
Medical officers who wish to utilize this air lift should
forward requests for reservations no later than 1 5
March 1965 to Director, Professional Division, Bureau
of Medicine and Surgery.
AMERICAN BOARD OF OBSTETRICS
The Part II examination will be conducted by the
American Board of Obstetrics and Gynecology at The
Edgewater Beach Hotel, Chicago, Illinois April 26-May
1, 1965. Candidates scheduled for examination are
urged to make their hotel reservations at an early date.
Applications for the Part II examination to be given
in April of 1966 will be accepted in the office of the
Secretary during April or May, 1965 and must be ac-
companied by duplicate lists of patients dismissed from
their service during the 12 months immediately preced-
ing date of application.
Current Bulletins outlining present requirements and
application forms may be obtained by writing to the
office of the Secretary. Applicants are urged to famil-
iarize themselves with the new rules and regulations
covering the new schedule of examination which goes
into effect this year.
Diplomates of this Board are requested to keep the
Board office informed of their current address.
Clyde L. Randall, M.D.
Secretary and Treasurer
American Board of Obstetrics and
100 Meadow Road
Buffalo, New York 14216
OPHTHALMIC PATHOLOGY COURSE
An additional course in Ophthalmic Pathology will
be conducted in Fiscal Year 1965 at the Armed Forces
Institute of Pathology, Washington, D.C, from 12
April through 16 April 1965.
Officers desiring to attend should submit their re-
quests, in accordance with BUMED INST. 1520.8A, to
this Bureau, Attention: Code 316, as soon as possible.
Early submission is necessary in order to comply with
the Army's request to return unused quotas 6 weeks in
advance of the convening date.
AMERICAN COLLEGE OF PHYSICIANS
This Annual Meeting will be held in Chicago, Illinois
on 22 through 26 March 1965. A special air lift de-
parting Andrews Air Force Base, Washington, D.C. at
1200 hours on 21 March and returning at 0800 hours
on 27 March from Glenview, Illinois is scheduled to
accommodate medical officers of the Armed Forces
who desire to attend this meeting.
Interested medical officers should forward requests
by message for reservations immediately to: Director,
Professional Division, BuMed.
NAVAL MEDICAL RESEARCH REPORTS
US. Naval Medical Research Institute, NNMC, Be-
th esda, Md.
1. Behavioral Contagion: MR 005. 12-2005.01 Report
2. Long-Term Intraoral Findings in Humans After
Exposure to Total-Body Irradiation from Sudden
Radioactive Fallout. I. Five Year Postdetonation
Studies: MR 005. 12-5300.01 Report No. 1, Jan-
3. Nematode Parasites From Mammals Taken on
Taiwan (Formosa) And Its Offshore Islands: MR
005.09-1606.01 Report No. 14, February 1964.
U.S. NAVY MEDICAL NEWS LETTER
4. Digenetic Trematodes of Fishes From Palawan
Island, Philippines. Part I. Families Acanfhocolpi-
Angiodictyidae, Cryptogonimidae, Fellodistomidae
and Gyliauchenidae: MR 005.09-1606.01 Report
No. 12, April 1964.
5. The Effect of Temperature and Hematocrit on the
Viscosity of Blood: MR 005.02-0020.01 Report
No. 3, June 1964.
6. Structure Vs. Toxicologic Parameters in New Esters
of Tropine and ty -Tropine. VI. : MR 005.06-0010.
01 Report No. 32, July 1964.
PULPAL REACTIONS TO CARIES*
Sadahiro Yoshida and Maury Massler, Dental
Abstracts 9(9): 551-553, September 1964.
Active and arrested caries of the dentin show im-
portant differences in ground and decalcified sections,
a histologic study of 98 teeth reveals.
In the active lesion, the ground section shows a sur-
face necrotic layer which appears soft, light brown,
cheesy and structureless. Below this layer always ap-
pears a wide, yellowish, decalcified layer. Sclerotic
dentin usually is absent or present in an extremely thin
layer under the decalcified layer. In the decalcified
sections of active lesions, the necrotic layer is hema-
toxylinophilic and not sharply demarcated from the
underlying decalcified layer. The decalcified dentin
contains tubules with basophilic granules, transverse
fissures and ampule-shaped cavitations.
In the arrested lesion, the ground section reveals a
thin or absent necrotic layer. The layer immediately
below is hard, leathery and heavily pigmented. A
prominent, white sclerotic layer always is present un-
der the pigmentation. In the decalcified sections of
arrested caries, the necrotic layer is absent or, if pres-
ent, is a thin, amorphous, faintly hematoxylinophilic
material clearly separated from the dentin layer below.
The pigmented zone usually is free of basophilic gran-
ules. No sclerotic zone can be distinguished.
No odontoblastic or pulpal responses were observed
under enamel caries. Under active lesions, a baso-
philic line appears at an early stage along the pulpal
border of the primary dentin. Under arrested lesions,
this line or stripe is found at the junction of the primary
and reparative dentin.
The pulpodentinal membrane subjacent to the lesion
often is absent or interrupted, especially during the ac-
tive stage of the carious attack.
Reparative dentin matrix appears to form during the
early stage of dentinal caries. Little additional repar-
ative dentin is formed during the later stages of ar-
* Copyright by the American Dental Association. Reprinted by per-
rested caries. Odontoblasts subjacent to the reparative
dentin under the arrested lesions are inactive, degen-
erated, atrophied or absent.
The human dental pulp shows a high reparative po-
tential. The amount of reparative dentin formed can
be correlated with the depth of the carious lesion. The
carious process shows a greater tendency to extend
along the junction between primary and reparative den-
tin rather than to penetrate directly through the repar-
ative dentin into the pulp. Except under deep dentinal
caries, the pulp tissue of most teeth shows no pro-
nounced inflammatory changes.
EFFECTIVENESS OF COPAL RESIN VARNISH
UNDER AMALGAM RESTORATIONS*
D. Barber, J. Lyell, and M. Massler, Dental
Abstracts 9(9): 562, September 1964.
When copal resin varnish is flooded into a prepared
cavity so that it covers the walls as well as the floor
of simple and compound amalgam restorations, the
varnish completely seals the margins of the restoration
against the penetration of ionic and molecular tracers.
How long such a seal remains effective is not known.
Cavities were prepared in freshly extracted cuspids,
bicuspids and molars. In the control Group I, Class V
and Class II preparations were restored immediately
with no copal resin varnish. In the teeth in Group II,
varnish was used only on the floor (axial wall), and the
Class V cavity preparations filled with silver amalgam.
In the Group III teeth, Class V cavities were prepared
and copal resin varnish was flooded into the cavity to
cover the walls and floor, after which silver amalgam
was condensed into the cavity.
Class II cavity preparations also were lined with
copal resin varnish, either by flooding the entire cavity
with the varnish, or by placing the varnish on only one
proximal surface of an MOD preparation before resto-
The roots of the teeth were covered with wax and the
teeth were immersed in S"' as sodium sulfate or Ca 45 as
* Copyright by the American Dental Association,
Reprinted by per-
U.S. NAVY MEDICAL NEWS LETTER
calcium chloride, or a dye tracer (a 3.18 per cent
solution of toluidine blue) was used. After immersion
for one week the teeth were sectioned longitudinally
and examined autoradiographically.
In the control group (Group I) teeth, dye and iso-
tope tracers had penetrated into all margins of the
restorations to the floor of the cavity only. The cavities
in Group III teeth which were flooded with the copal
resin varnish showed a complete absence of dye or
isotope penetration. Compound cavities with varnish
on one proximal surface showed a complete lack of
isotope or dye penetration on the varnished side, but
the unvarnished side showed deep penetration. In vivo
clinical testing is in progress to determine how long the
varnish is effective as a sealer.
R. W. Phillips, research professor in dental materials
at Indiana University School of Dentistry, comments
"Evidence accumulates to indicate that cavity var-
nishes serve a useful role in restorative dentistry. How-
ever, certain of the variables associated with their use
need further investigation. One of those facets has been
explored in this report. The results of this study clearly
indicate that a continuous coating of the varnish over
the entire cavity preparation is essential if maximum
protection against the seepage of deleterious agents is
to be attained. Although for the purpose of the study
the investigators "flooded" the cavity preparation with
the varnish in order to assure a complete coverage of
all surfaces, it should not be inferred that the clinical
application of a varnish is not to be done delicately.
Gross excesses at the margins prevent proper finishing
of the amalgam tooth margin. Likewise, the varnish
should be applied in several thin coatings, not as a
thick, viscous single layer. A better seal is attained
with several thin coatings than by a thick consistency
varnish. If the varnish becomes viscous it should be
thinned by an appropriate solvent.
"The authors properly emphasize that further in vivo
testing will be required to determine if the exceptional
seal provided by the varnish deteriorates at the exposed
marginal areas. Observations in several well-controlled
dental practices have shown no apparent breakdown in
this area after as long as eight years of clinical service.
However, further documentation is necessary.
"Although this research indicates that with the amal-
gam restoration it might actually be advantageous to
bring the varnish to the margins of the cavity prepara-
tion, a comparable conclusion does not necessarily fol-
low with all other restorative materials. For example,
it is known that the varnish is especially valuable to the
silicate restoration as it minimizes the penetration of
acid from the silicate gel into dentin. However, in this
instance it may be desirable to remove the varnish from
the margins so that the complete effect of the fluoride
in the silicate may be attained. The presence of the
varnish at the critical marginal areas does inhibit some-
what the reaction of the fluoride with tooth structure
and thus prevents maximum reduction in enamel solu-
"This research corroborates previous studies in this
field and fills a void relative to the correct clinical usage
of cavity varnishes."
EFFECT OF POWERED TOOTHBRUSHING
PLUS INTER-DENTAL STIMULATION UPON
THE SEVERITY OF GINGIVITIS
Irving Glickman DMD, Richard Petralis DDS, and
Robert M. Marks DDS, Jour Periodont 35(6): 69-74,
The introduction of automatic toothbrushes has fo-
cused attention upon toothbrushing and interdental
stimulation in terms of gingival health. Numerous in-
vestigations have reported more beneficial effects with
the automatic toothbrush than with the hand tooth-
brush, but the findings have not met with universal
acceptance. Because of the interest in this phase of
periodontics, a clinical study was conducted to com-
pare the effect of powered toothbrushing with powered
toothbrushing plus interdental stimulation upon the
condition of the interdental gingival papillae. The study
showed that powered toothbrushing with the use of an
interdental stimulator adapted for the powered tooth-
brush reduced the severity of interdental gingival in-
flammation by an average of 26.3%.
Powered toothbrushing plus interdental stimulation
was equally effective on the maxilla and mandible ex-
cept for the lingual surface of the mandible. Greatest
improvement in the gingival condition following pow-
ered toothbrushing plus interdental stimulation occurred
on the facial surface of the mandibular right posterior
area; least reduction in gingival inflammation occurred
on the lingual surface of the mandibular left posterior
The maximum difference between the percentage re-
duction in interdental gingivitis following powered
toothbrushing alone as compared with powered tooth-
brushing plus interdental stimulation occurred on the
lingual surface of the mandibular anterior segment.
In this area gingivitis was reduced 26.3% following
powered toothbrushing plus interdental stimulation and
1,4% following powered toothbrushing alone.
It was not established whether the effects of tooth-
brushing and interdental stimulation are derived from
cleansing action or massaging or both.
SU PPLEMENTATION *
Richard E. Jennings and Robert T. Culpepper,
Dental Abstracts 9(9): 581, September 1964.
The effect of supplemental fluoride in combination
with other compounds on either caries or enamel mot-
' Copyright by the American Dental Association. Reprinted by per-
U.S. NAVY MEDICAL NEWS LETTER
tling cannot be predicated. Strong motivation on behalf
of both parents is necessary to dispense supplemental
fluoride properly over a long period and to prevent ex-
cessive consumption. Supplemental fluoride prepara-
tions cannot be considered a satisfactory substitute for
either the consumption of fluoridated water or the ap-
plication of a concentrated topical fluoride to the teeth
in the dental office.
As noted by Hennon and Muhler (1962), caution is
necessary in anticipating results to be obtained from
extradietary fluoride administration when comparing
such administration to a fluoridated public water sup-
ply, since the two methods differ drastically. Even
though it is possible to ingest the same total amount
of fluoride each day from either source, the duration
of blood availability and the peaking of fluoride ions in
the blood undoubtedly are different. In a quart of
drinking water fluoridated to 1.0 mg. per liter, a child
would consume 1.0 mg. of the fluoride ion in small
doses over a long period. If 1 mg. of fluoride were
ingested in a single dose, it would be rapidly eliminated
by the kidneys, with only a transitory amount available
to the developing teeth.
Consumption of fluoride from a fluoridated water
source supplies fluoride to the body during various
periods of the day and maintains a more constant blood
level. Also, it increases the food fluoride content since
fluoridated water is used in the preparation of the
meals. Studies on both animals and human beings show
that the fluoride tablet taken once daily does not dupli-
cate the blood picture of one drinking fluoridated water,
and as a result may not duplicate the decay preventive
effect in the teeth.
The effect of a fiuoride-multivitamin preparation on
caries has not been investigated in children but, in ex-
periments in the monkey, there are indications that
vitamins A, C, and D influence fluoride metabolism.
Thus, the physician who prescribes vitamin prepara-
tions containing fluoride cannot be assured that the
fluoride will be effective nor can he predict the effect
on enamel appearance (mottling).
Any fixed combinations of fluoride with other nutri-
ents increase the difficulty of adjusting the prescribed
fluoride to allow for fluoride levels already in the
child's drinking water, since alterations of the dose
also will alter the vitamin intake.
DENTAL X-RAY EXPOSURE OF SITES WITHIN THE HEAD AND NECK
A. G. Richards MS, Ann Arbor, Michigan and R. L. Webber DDS, San Francisco,
Calif., Oral Surg, Oral Med, and Oral Path, 18(6): 752-756, December 1964.
The article cites an investigation carried out to de-
termine the amount of radiation to which selected
sites within the patient's head and neck are exposed
during posterior bitewing and periapical X-ray exam-
inations. The results, shown in the tables that follow,
indicate that, with few exceptions, the exposures made
with 65 and 90 KVP were comparable, and that all
were relatively low compared with earlier studies re-
ported in the dental literature.
Lens of eye
Anterior tongue at midline
Posterior tongue at midline
Per cent of
Per cent ot
U.S. NAVY MEDICAL NEWS LETTER
Per cent of
Per cent of
Lens of eye
Anterior tongue at midline
Posterior tongue at midline
PERSONNEL AND PROFESSIONAL NOTES
Policy on Ultrasonic Instrumentation in Periodontal
Therapy and Oral Prophylaxis. The Dentsply-Cavitron
Ultrasonic Dental Unit, FSN 6520-890-1584, is avail-
able to naval dental activities. Due to early reports of
potential oral tissue damage from this instrument, Bu-
Med policy has limited its use to dental officers with
A recent thorough review of the published literature
(U.S. Navy Medical News Letter 44(12): 12, 25 Dec
1964) indicated that no significant injury occurs when
this instrument is used with appropriate knowledge,
care, and skill. The bulk of evidence indicates that
this instrument is an excellent adjunct to periodontal
therapy. The evidence also justifies authorization of
properly trained and supervised dental technicians to
use this instrument for removal of supragingival cal-
Appropriate special training in use of this instru-
ment is available in the five-day course in "Perio-
dontics" given at the Naval Dental School. Comparable
special training is also offered at some civilian dental
schools in the form of short postgraduate courses and
may be supported by BuMed funds.
Appropriate formal training for dental technicians
is not available. To date, such training is available
only from local dental officers who are so trained. It
is emphasized that the supervising dental officer will
always be responsible for the patient care performed
by his auxiliary personnel.
Dental Corps Contributes to International Relations.
A recent issue of The Observer, published by MACV,
for U.S. Forces in Vietnam, carried an article on fabri-
cation of artificial eyes at the Cong Hoa Hospital in
Saigon. Development of this program is an excellent
example of the manner in which CAPT Glen D. Rich-
ardson DC USN has contributed to international rela-
tions, as well as to the health and well-being of allies,
by transmitting to allied officers the knowledge and
skills gained from U.S. Navy Dental Corps training
Until last August, the only prosthetic eyes available
in Vietnam were imported from Japan. CAPT Rich-
ardson, stationed at Headquarters Support Activity,
Saigon, noted that several wounded soldiers at the
Cong Hoa Hospital were missing eyes. CAPT Rich-
ardson made known to the hospital authorities that
both he and his prosthetic laboratory technician, DTI
Gradie K. Maness, had been trained in maxillofacial
prosthetic technics at the U.S. Naval Dental School,
National Naval Medical Center, Bethesda, Maryland.
Upon request of the hospital authorities, CAPT. Rich-
ardson initiated a part-time training program for the
dental staff, headed by CAPT Nguyen Van Dom, in
February 1964. Since August, over 35 patients have
been fitted with eye prostheses by the Vietnamese den-
tal staff. The technic for fabrication of artificial eyes
and other maxillofacial prosthetic appliances by the
adaptation of dental prosthetic materials and methods
was developed at the U.S. Naval Dental School during
World War II and the years immediately following.
Many World War II eye casualties were treated. Dur-
ing recent years, the Navy Dental Corps has main-
tained the capability for maxillofacial prosthetic service
at the U.S. Naval Dental School and at the U.S. Naval
Hospital, San Diego, California. In 1963 and 1964
respectively, totals of 376 and 321 maxillofacial pros-
thetic appliances were fabricated at those two naval
The Navy Dental Corps maintains capabilities in
these unique technics by means of a continuing training
program for specially selected prosthodontists and
prosthetic laboratory technicians at the Naval Dental
School should the need arise in the event of a national
U.S. NAVY MEDICAL NEWS LETTER
(Photo compliments of The Observer. Legend: Viet-
namese soldier gets artificial eye. Dental officers
Khang and Richardson at work.)
Navy Dental Officer Presentations. CAPT Fred L.
Losee DC USN, Dental Research Officer, U.S. Naval
Training Center, Great Lakes, Illinois was recently
invited to present talks before three professional so-
cieties in Chicago, Illinois.
On 12 January 1965 he spoke before the Chicago
Section of the Society for Applied Spectroscopy on
"Trace Minerals and Dental Caries." On 1 February,
he presented a talk entitled, "Soil and Its Relation to
Dental Caries" before the Odontograph Society of Chi-
cago, and he was invited to present a talk on 24 Feb-
ruary entitled, "Caries, Cancer, and Coronary Disease
— Is there a Relationship?" before the Chicago Dental
American-Philippine Dental Seminar Held at Sangley
Point. CAPT R. F, Erdman DC USN, Dental Officer,
U.S. Naval Station, Sangley Point, P. I. hosted a dental
seminar for the Philippine Dental Association in De-
Those attending the session included Doctor Ursua,
President of the Philippine Dental Association; Doctor
Rodriguez, Dean of the Dental School, University of
the Philippines; COL D. Santos, military representa-
tive; and presiding officers of the various local chapters
of the PDA throughout the island of Luzon. Also
present were U.S. Navy dentists from Subic Bay, San
Miguel, and Cubi Point. Presentations were made by
three dental officers of the Sangley Point Naval Station.
LCDR W. L. Sullivan DC USN presented an illustrated
paper on the "Amalgam Alloy Restoration." LT E. F.
McGee DC USN presented a paper on "Preparation
U.S. NAVY MEDICAL NEWS LETTER
and Filling of Root Canals," supported by two of the
Navy Dental Corps training films. LT M. F. O'Halloran
DC USN presented a "Comparison in Modern Fluori-
Navy Dentist Honored by Dental Societies. CAPT
Angus W. Grant DC USN, Executive Officer, U.S.
Naval Dental Clinic, Long Beach, California recently
was elected to serve as President of the American
Academy of Oral Roentgenology for 1965 and is to
serve as the Vice Chairman for the Section of Oral
Roentgenology for the 1965 Annual Session of the
American Dental Association.
Dental Training Program for Peace Corps Physicians
is Given Assistance by Navy Dental Corps. The chief
dental officer of the Peace Corps has announced that
material and techniques developed in the course for
submarine medical officers in the management of den-
tal emergencies have been used in teaching Peace
Corps physicians. Peace Corps physicians have the
responsibility of supervising the oral health of the
volunteers in the field in isolated areas. This respon-
sibility closely parallels that of the medical officers on
fleet ballistic missile submarines. It was possible, there-
fore, for the Submarine Medical Center, Submarine
Base New London, Groton, Connecticut to give some
assistance to the Peace Corps dental officer in setting
up a training program for physicians. The course at
New London, taught by LCDR W. R. Shitler, DC USN,
is a regular part of the School of Submarine Medicine
curriculum. The course consists of eight hours of
lectures, two hours of practical training in manipula-
tion of materials, and ten hours of rotating clinical
observation. The clinical periods are given at the
Submarine Base Dental Department. CAPT G. O.
Stead is the Submarine Base Dental Officer.
Disposition of Dependent Dental Records. Change
Number 1 to SECNAVINST P-52I2.5B, Disposal of
Navy and Marine Corps Records, authorizes the de-
struction of dependents dental health record jackets,
including SF-603 and roentgenographs, two years after
sponsor has been detached from local duty station.
Reserve Dental Officers Participate in Casualty Care
Training. CAPT. G. R. Shaver DC USN, ELEVENTH
Naval District Dental Officer, scheduled a Casualty Care
Program for thirteen Naval Reserve dental officers at
the U. S. Naval Training Center, San Diego, California
4-7 December 1964. CDR W. J. Jasper and LT M. C.
Clegg DC USN instructed the course 'which included
officers of dental reserve companies 11-1, 11-3, 11-4,
1 1-5 and two active duty dental officers.
Naval Dental School Sends 32 Technicians to the Fleet.
Certificates for successful completion of advanced and
specialized training courses in the Enlisted Schools of
the U. S. Naval Dental School were awarded to thirty-
two dental technicians at graduation exercises on 18
December in the Main Auditorium, National Naval
Medical Center, Bethesda, Maryland.
"An Extra Pair of Hands" was the theme of an ad-
dress to the graduates by CAPT William R. Stanmeyer
DC USN, Staff Dental Officer, Severn River Naval
Command, and the Dental Officer, U. S. Naval Acad-
emy, Annapolis, Maryland.
CAPT A. R. Frechette DC USN, Commanding Of-
ficer of the U. S, Naval Dental School, presented letters
of commendation to those students with the highest
averages in their respective fields of dental technology:
Donald G. Woolridge DTI, Advanced General; Stanley
J. Richings DTC, Advanced Prosthetics; and Robert S.
Weldy DT2, Basic Repair.
Eldor R. Oien DT2, received the ninth Thomas
Andrew Christensen Award in recognition of his loyalty
and devotion to duty in the U. S. Navy. Established by
the Naval Dental School to honor the only naval dental-
man posthumously presented the Navy Cross for extra-
ordinary heroism, the award is presented, from time to
time, to a graduate of an enlisted school who is chosen
on the basis of his service record and service reputation.
RADM Frank M. Kyes, Assistant Chief of the
Bureau of Medicine and Surgery (Dentistry) and Chief
of the Dental Division, assisted by CAPT R. R. Trox-
ell DC USN, Head of the Enlisted Education Depart-
ment, awarded certificates to twenty graduates of the
Advanced General School, ten of the Advanced Pros-
thetic School, and two of the Basic Repair School.
Music was provided by the String Ensemble of the
Marine Band under the direction of MGY-SGT William
AVIATION MEDICINE SECTION
MEDICAL ASPECTS OF OPERATION SEA ORBIT, THE
FIRST AROUND-THE-WORLD CRUISE BY NUCLEAR
POWERED SURFACE SHIPS*
CDR F. H. Austin, Jr. MC USN, Medical Officer, USS Enterprise (CVA(N)65) and
TF-ONE, F.P.O., New York, N. Y. 09501.
Task Force One formed at I200Z on 3) July 1964
under the command of RADM B. M. Strean, U. S.
Navy. The force was composed of the three nuclear
powered ships, USS Enterprise (CVA(N)65), USS
Long Beach (CG(N)9), and USS Bainbridge (DLG-
(N)25). fts mission was to conduct an around the
world cruise (over 30,000 miles) in sixty five days
without logistic support.
The force departed the Straits of Gibraltar and took
a route south down the west coast of Africa, around
the Cape of Good Hope, north up the east coast of
Africa to Karachi, Pakistan. From Karachi the force
proceeded down the west coast of India around Ceylon
then southeast to Freemantle, Australia and eastward
to Melbourne and Sydney. The final route homeward
bound departing Sydney and Wellington, New Zealand
crossed the South Pacific, rounded Cape Horn, pro-
ceeded up the east coast of South America, stopping at
Rio de Janeiro, and from there to Norfolk, Virginia.
The primary overall objectives of Operation Sea
Orbit were to test the capability of these ships to
cruise at high speed indefinitely in all environments of
the sea and weather without replenishment of any kind
* This article is an unclassified rewrite of the Medical Chapter con-
tained in Commander Task Force One's Sea Orbit Cruise Report
of 3 October 1964.
and to show the ships and their aircraft to the peoples
of countries along the way. Several secondary objec-
tives were also realized.
The Medical Department's view of Sea Orbit focused
on the concept of a relatively extended cruise with long
at-sea periods and short in-port liberty (rest and recrea-
tion) periods. This was combined with visits to un-
familiar ports and areas of the world, rapid climatic
changes, and particularly the concept of essential isola-
tion, in that no stores or supplies (medicine, fresh
provisions, etc.) would be received and no medical
The cruise began 31 July 1964 from the Straits of
Gibraltar and terminated in Norfolk, Virginia on 3
October 1964 (64 days). The ports of call were:
Karachi, Pakistan; Sydney, Australia; and Rio de
Janeiro, Brazil (Enterprise); Karachi; Freemantle, Au-
stralia; Wellington, New Zealand, and Rio (Bainbridge):
Karachi, Melbourne, Austrialia: Wellington and Rio
The complement of officers and crew of Enterprise
was 4,244, Long Beach 941, and Bainbridge 421. En-
terprise had six (6) Medical Officers aboard, Long
Beach and Bainbridge had one each, The Medical Of-
U.S. NAVY MEDICAL NEWS LETTER
OPERATION SEA ORBIT, TASK FORCE ONE MEDICAL STAFF: (L to R) Drs
Jim Snyder, Stuart Fleming, Cary Hodnett, Mario Rosa-Garcia, R. Bendixen, Frank
A-ustin, Ben Jenkins (MSC), Don Gaylor and Hal Cotnpton. (Official Photograph,
U. S. Navy.)
ficer of Enterprise served TAD as TF-ONE Medical
Officer. Three all-force Medical conferences were held
aboard Enterprise during the cruise, for the exchanging
of medical intelligence and for professional stimulus.
Medical officers from accompanying ships were trans-
ferred by helicopter.
General Considerations, The planning and logistics
for Sea Orbit began early in the normal Mediterranean
deployment when the cruise was first proposed. The
drug and material requirements for the additional 65
days underway were well within the normal reserve
held aboard each ship. All supplies were rechecked
against up-dated usage rates, anticipating an increase
in elective surgery and dental care, due to the pro-
tracted at-sea period. All needed supplies were obtained
through normal channels by the last at-sea replenish-
The only additional immunization requirement over
those necessary for the Mediterranean was a cholera
booster. All hands on Enterprise were scheduled for
this shot during the Naples in-port period in order to
utilize the immunization gun of PMU-7. Long Beach
and Bainhridge utilized needles. Stragglers were im-
munized thereafter and records screened on all per-
sonnel for currency of immunizations. As usual this
program proved to be protracted and frustrating until
all hands were current, both with immunizations and
their record cards.
Psychiatric problems and morale factors were not
unusual in numbers or. degree, but as expected they
occupied a good deal of the Medical Department's time
along with the Chaplain's and Personnel Offices. Just
prior to outchop, several requests from the Red Cross
required evaluating to judge emergency leave justifi-
cation. The prospect of an added two months to the
normal deployment evoked some distress among a few
personnel and/ or their dependents. In most cases these
problems worked out satisfactorily without leave. After
the cruise was underway and isolation made emergency
leave impractical, all personnel settled down to the
serious job at hand.
Advanced medical information on the ports to be
visited was obtained from Preventive Medicine TJnit-7,
Naples, COMMIDEASTFOR, CINCLANTFLEET and
from the ALUSNAs concerned. The preventive medi-
cine problems of concern were endemic Malaria in
U.S. NAVY MEDICAL NEWS LETTER
tropical Africa areas, (involved only the liaison and
C.O.D. crews), enteric disease hazards in Karachi, and
the Yellow Fever, Malaria, enteric disease and venereal
disease risks of South American ports. Personnel were
indoctrinated concerning the hazards from contaminated
food and drink and mosquito-borne diseases. The in-
tensive command and medical programs relative to
venereal disease education and prevention were con-
tinued during Sea Orbit. The incidence of all diseases
was low, probably attributable mostly to the short
liberty visits and thus the reduced exposure.
Transit, Phase One. No significant medical or surgi-
cal problems were encountered in transit around Africa
and into Karachi. The advanced liaison parties and
all C.O.D. Aircraft crews were begun on malaria pro-
phylaxis utilizing one combined chloroquine — prima-
quine tablet once per week in accordance with
BUMEDINST 6230.1 1C.
The aircraft (CIA's), returning aboard from all air-
ports were sealed and sprayed to kill insects.
On 4 August, at sea off Liberia, a GMCS aboard
Bainbridge died of myocardial infarction. His remains
were transported by helo to Enterprise, prepared by a
licensed embalmer and air evacuated by CIA to Roberts
Field, Monrovia for air shipment home. ALUSNA,
Monrovia arranged details for the remains (and escort)
which arrived in Charleston, S. C. on 8 August, thus
greatly relieving the stress on the next of kin. The
remains could have been retained aboard for burial at
sea or return to CON US had this been an operational
The first all-force Medical Conference was held on
12 August and anticipated problems of the Karachi port
On 19 August the advanced party was flown into
Mauripur Airport, Karachi and several personnel, in-
cluding the disbursing officer and pilots were quar-
antined because of "improper medical shot records."
It was subsequently learned that the health officers had
questioned the absence of a certification stamp over
the Medical Officer's signature, especially for yellow
fever. This stamp is required on the International Cer-
tificate, PHS Form 731, but is specifically not required
for the Military Form 737 (white card) in accordance
with BUMEDINST 6230. ID. However, in order to
avoid further difficulties, all personnel going to the air-
port thereafter were issued International Cards and DD
Form 737 entries for Smallpox, Cholera, and Yellow
Fever were all stamped. It is considered advisable for
crews flying into International airports to possess a
PHS Form 731 (yellow card) as well as the DD Form
737, the entries of which have been properly signed
Port Visit, Karachi (20-21 August), Bainbridge
moored alongside a pier while Long Beach and Enter-
prise anchored out. The rough seas restricted boating
and limited the liberty party to a total of approximately
2,500 personnel from the three ships for the day and a
Eight doctors from the Basic Science Medical In-
stitute (operated on aid by the University of Indiana)
at Jinnah Hospital were invited in advance and visited
Bainbridge and Enterprise on 21 August. Dr. Harold
Margulies, the Director from University of Indiana,
was accompanied by three other United States and
four Pakistani doctors.
The Pakistan Director of Naval Medical Services,
Commodore S.H.A. Gardezi, hosted the Medical
Officers to lunch and a tour of the Naval Hospital
Personnel going on normal liberty were considered
by TF-ONE Medical Officer to be at minimal risk
from malaria. However, instructions dictated that
chemoprophylaxis be given. This was accomplished by
administering one tablet of combined chloroquine-
primaquine 48 hours prior to port entry so that possible
enteric upsets would not be confused with diarrhea
which might be the result of eating and drinking ashore.
All Karachi Medical personnel consulted were of the
opinion that the risk in metropolitan Karachi for the
short visit was slight.
The incidence of enteric disease in the population
had been diminishing over the last week prior to
TF-ONE's visit. A minimal number of personnel
suffered diarrhea following the visit, and no patho-
genic organisms were cultured.
Camel saddles and fur hats were purchased at the
native markets in large numbers by the crews. The
hats were found to harbor lice and were subsequently
disinfected with DDT powder. The saddle pads con-
tained unsterilized raw cotton. These were all unstuffed
and the cotton discarded so as to avoid problems of
the importation of this material into CONUS.
One crewman of Enterprise was bitten on the finger
by a pet monkey. Because the incidence of rabies was
reported as high, this man was treated with a course
of rabies vaccine (duck embryo). No complications
Just prior to port entry, an Enterprise helicopter
crashed at sea. All four personnel were rescued after
a few minutes in the water. While attempting salvage,
skin divers spent about 45 minutes in the water which
was infested with long, yellow sea snakes, reported to
be poisonous. No personnel were bitten, but these
snakes were discussed with Karachi medical personnel
who confirmed that they were poisonous and that a
polyvalent antiserum was available at hospitals in
The hospitals of Karachi requested blood donors and
twenty one personnel donated blood ashore.
Venereal exposure was estimated to be low. One
case of gonorrhea and one of chancroid were reported.
Transit, Phase Two, An unusually low number of
diarrhea cases (15) occurred in the three days follow-
U.S. NAVY MEDICAL NEWS LETTER
ing Karachi. The episodes were self-limited, no sec-
ondary cases occurred and no pathologic organisms
The Long Beach Medical Officer performed his sec-
ond emergency appendectomy of the cruise on 23
The second all-force Medical Conference was held
aboard Enterprise on 26 August. Problem medical
cases were presented for discussion and professional
ALUSNA Canberra sent the following message on
19 August: "GO A Department of Health requires that
the following statement from Senior Medical Officer
TF-ONE must be received and acknowledged by Direc-
tor of Health, Perth, Western Australia prior to takeoff
of any flights enroute Perth. No quarantinable disease
on board any ship in TF-ONE including Smallpox,
Cholera, Yellow Fever, Plague, Typhus and no com-
municable disease on board. All personnel (Military
and Civilian) embarked in TF-ONE have been vac-
cinated against Smallpox. Signed (Name, and Rank of
Medical Officer). This statement will be considered
effective for all Australian Port visits and all flights
landing in Australia from Enterprise. NOTE: A com-
municable disease will not affect port clearance but
must be made known to health authorities. Department
of Health states that they will accept a statement which
is initiated up to 48 hours prior to ETA of COD air-
craft". This required Pratique message was sent on 28
August, Priority/Unclassified, Action ALUSNA CAN-
BERRA, who passed it to Health Authorities and re-
layed acknowledgment and clearance.
Until about 28 August the full range of fresh vege-
tables was available. Thereafter for another two weeks,
carrots and celery remained, Then only fresh apples
and dehydrated, canned, and frozen fruits were avail-
able. No vitamin deficiencies were anticipated and none
were seen in the personnel. Supplemental vitamins were
not deemed necessary and were medically prescribed
only on an individual case basis. Personnel were en-
couraged to drink fruit juices and eat the wide variety
of foods offered.
Port Visits, Australia and New Zealand. There were
no preventive medicine problems anticipated from the
visits to Australia and New Zealand ports. Reception
of the personnel was overwhelming, and an estimated
8,205 liberties were made by Enterprise personnel in
Sydney during the two and a half day visit (4, 5, 6
September 1964). A similar welcome and percentage
of liberties were experienced by Long Beach and Bain-
bridge in Freemantle and Melbourne, Australia and in
Wellington, New Zealand.
Only one man was injured in Sydney. This was due
to an auto accident in which he sustained a lacerated
lip and moderate concussion. He was well treated at
Prince Alfred Hospital and released to return to
A young female kangaroo (18 months old) was ac-
quired from the Taronga Zoological Park, Sydney for
transportation to the Norfolk Zoo. The Director issued
a "live stock certificate and declaration" which stated
that the animal was "free from all infectious and con-
tagious diseases", and "has not within the next preced-
ing six months been in direct or indirect contact with
stock infected with any such diseases". Except for
some mild diarrhea, perhaps seasickness, and slight
weight loss, the kangaroo took the trip well aboard
Enterprise, and presented no health hazard. No quar-
antine problems were encountered in importing the
animal into CONUS.
Transit, Phase Three. No enteric disease outbreaks
occurred following the Australian and New Zealand
visits. Venereal disease incidence was low.
Morale was distinctly boosted by the visits to these
friendly English speaking countries.
During this transit, at a longitude of approximately
40° South, the task force passed through a time zone
each day, losing an hour each twenty four. This dis-
ruption of the Circadian Cycle (physiological clock
mechanism) resulted in fatigue. The crew remained
busy with training exercises and no major deleterious
effect was encountered.
The third all-force Medical Conference was held on
1 8 September and anticipated problems in South Amer-
ican ports were discussed.
A slight increase in non-aviation accidents and in-
juries was noted. This was attributed in part to high
winds and rough seas, but emphasis on the ship's
general safety programs was intensified.
A medical information report requested from ALUS-
NA Rio by message arrived with the first mail from
Montevideo. No information on venereal disease was
available. From this letter, warnings concerning eating
of unwashed vegetables were disseminated to the crew,
as well as the information that the incidence of typhoid
fever, amebic and bacillary dysentery and hepatitis was
The following message was sent to ALUSNA Rio.
"Pass to port director. ATTN Health Officer. Pratique
certified TAW Gen Order 20, No international quaran-
tinable diseases and no other communicable diseases
aboard any ships TF-ONE. All military and civilian
personnel have received Smallpox and Yellow Fever
immunization.. Each ship has a medical officer em-
barked. Enterprise has on board one kangaroo in pos-
session of health declaration for absence of disease or
exposure for six months. Will not land animal. No
other animals or birds aboard. CDR Frank H. Austin,
Jr. MC USN, Medical Officer TF-ONE certifies".
In anticipation of a high venereal disease risk, the
preport Petty Officers' Venereal Disease Meetings were
given special emphasis, with the stress being placed on
hazards of spread into CONUS with only nine days
to go until arrival.
U.S. NAVY MEDICAL NEWS LETTER
Port Visit, Rio de Janeiro (23-24 Sept 1964). No
problems were encountered with quarantine declara-
tion. Approximately 2,500 personnel were on liberty
ashore each of the two days. No significant injuries
or medical emergencies were encountered.
The openly accepted custom of street and bar "solici-
tation" indicated that venereal exposure rate might be
extremely high. Numerous cases of the various ve-
nereal diseases were subsequently diagnosed.
Transit, Phase Four, The first case of gonorrhea
appeared on the evening of 25 September an incubation
period of just 48 hours.
No medical problems were encountered during the
transit period from Rio to CONUS. The standard
Pratique message was sent to the Naval Station, Nor-
folk and advance liaison concerning the kangaroo and
medical patients for transfer to hospitals was provided.
One patient on Enterprise was tentatively diagnosed
as having malaria on 25 September. His symptoms had
begun on 10 September, twenty days after one day's
liberty" (exposure?) in Karachi. He had taken one
combined Chloroquine-primaquine tablet prior to
Operation Sea Orbit offered a unique opportunity
(the first) for the Health Physics Sections of Task
Force One to measure the atmospheric radiation levels
around the world and in both hemispheres. The con-
tinuous monitoring of the air, "swipe" and water
a. That the fall-out levels along the track of Sea
Orbit are at present negligible.
b. That radioactive contamination from nuclear
powered ships is nil.
Through a visual demonstration, as part of the
presentation for visitors, the safety of nuclear reactors
was vividly displayed.
Surgical Experience: No unusual incidence of surgi-
cal disease appeared. Enterprise performed five appen-
dectomies, Long Beach three. Enterprise had six major
emergency cases (hand and arm traumas), Long Beach
two, and Bainbridge two. Heavy seas resulted in four
moderate to severe injuries aboard Long Beach and
Bainbridge. Enterprise surgeons performed over 148
elective minor and major surgical procedures during
the cruise, thus maintaining the Surgical section in a
high state of readiness.
Medical Experience: Bainbridge had one death due
to myocardial infarction and two cases of ureteral ithia-
sis were seen. Long Beach encountered 105 cases of
upper respiratory infection in August and 48 cases in
September. Enterprise reported no unusual prevalence
of medical diseases.
Psychiatric Experience: The majority of the crews
tolerated the isolation and long steaming periods well.
Long Beach transferred one case diagnosed as Para-
noid Personality to Enterprise for disposition. The
usual incidence (5-10 cases per week) of moderate
anxiety reaction was seen and treated by the various
Medical Officers. Morale was generally high, with
some exceptions. These were attributed not so much
to Sea Orbit, itself, as to the fact that the ships had
already been deployed for about six months when the
Operations began. No psychiatric limiting factors to
the extended operation of a Nuclear Task Force could
be anticipated from the experience of Sea Orbit, ex-
cept that careful personnel screening, of the nature
used for Antarctic wintering-over parties, would reduce
the numbers and severity of problem cases.
Preventive Medicine Experience: All immunization
records were screened, with special attention being
given to cholera and yellow fever. No personnel con-
tracted any non-venereal communicable disease ashore.
The Karachi visit yielded approximately 20 cases of
gastroenteritis on the three ships, with no specific patho-
genic organisms being cultured, and no secondary cases
developing. Venereal disease incidence was low from
Karachi (1) and Australia/ New Zealand (II). The
final figures for Rio de Janeiro surpass 40 cases. Sev-
eral cases of gonorrhea with an incubation period of
only 48 hours developed following this port visit.
Aviation Medicine Experience: Two aircraft were
lost during the cruise with all personnel being recov-
ered. Both were due to material failure, a UH2A
on 20 August and an A5A on 27 September. The Air
Group flew 18 fire power demonstrations and 8 fly
overs and had 9 days of limited flight operations for
training and test. The reduced operating pace caused
no major difficulties. The need for assuring perfection
and safety with infrequent flights was trying to morale
but was a demand which the Air group and associated
ships' departments performed well. The Flight Sur-
geons detected no pilot or air crew difficulties associated
with the operation.
In anticipation of increased dental work load, the
department augmented supplies prior to departure from
the Mediterranean. Enterprise facilities included six
operatories with five Dental Officers assigned.
The average work load during the prior deployment
had been 2,200 procedures per month. During August
the department performed 1,000 fillings, 200 extrac-
tions, 2,586 preventive dental, endodontic and perio-
dontic procedures and delivered 36 prosthetic appli-
ances. September figures were comparable. This
increased work load was attributable to the additional
availability of patient personnel during the longer at-
sea periods and slackened aviation operations.
The two qualified oral surgeons aboard provided the
coverage for maxillofacial surgery and backup for
U.S. NAVY MEDICAL NEWS LETTER
There were no serious dental emergencies and no
problems other than increased material usage rates
attributable to Operation Sea Orbit.
There were no medical, surgical, psychiatric, pre-
ventive medical or dental factors which limited the
readiness of Task Force One during Operation Sea
The incidence of all diseases and conditions was not
significantly increased over the experience of normal
The Medical Officers of large Nuclear Task Forces
planning more extended operating periods and isolation
a. Anticipate greatly increased usage rates of some
drugs and material.
b. Consider careful medical and psychiatric screen-
ing of personnel to strengthen Force morale and reduce
psychogenic problem cases.
AFTER THAT "HAIRY ONE"
CDR John J. Gordon MC USN, Manned Spacecraft
Center, National Aeronautics and Space Administra-
tion, Houston, Texas.
"Comes a pause in the day's operations!" This could
present no better opportunity for the Flight Surgeon
after a pilot has had an accident or has made one of
those "beautiful saves" following a "hairy situation".
There are few things outside of a forceps rotation
during a transverse arrest in prolonged labor, or a
strangulated bowel, which take precedence over the
post-situational examination and interview of an aviator.
He may be bathed in his own perspiration or the salty
water of the mother sea. In either case, once any
injury is diagnosed and satisfactorily treated, or in the
case of no injury, it is vitally important that this avi-
ator have a chance to talk. It may begin with his
description of what happened or a mountain sized
diatribe garnished with all the invectives of modern
man. It behooves the Flight Surgeon to start this flow
with either a few leading questions or an appropriate
observation, and the subtility of the traditional two
ounces of brandy.
Once the aviator begins to talk do not interrupt other
than to lead the narrative gently toward salient points.
Stand by for a wealth of information and attitudes con-
cerning himself, his job, the CAG, his skipper, the
bull ensign (perhaps wingman), the LSO, wife, family,
girl friend or even the old Doc himself.
Our aviator may now find himself in the position of
making an admission that he was or is afraid. Make
it easy for him to express his fear but do not express
it for him. Let him talk about it, mull it over and
realize that fear can be a normal healthy emotion. At
the same time, try to discover if his particular brand
of fear is transient and produced by the situation or
the more sinister kind which pervades him constantly,
consciously or subconsciously.
The attitude toward fear in most squadrons, par-
ticularly among junior pilots, is the fear of fear. The
more senior pilots have experienced the embrace of
fear and readily admit it. This attitude being dissem-
inated to junior pilots through casual discussion is very
revealing and necessary to them. It is important that
the aviator have an adequate understanding of fear.
If in the months of association you think you know
this aviator, you are now in a position to correct or
augment your opinion. This is one fleeting moment
when you may strengthen the bond of understanding
and also let him convey his true feelings while allowing
him the dignity of his calling as a man and aviator.
In any case nothing shocks the interviewer.
The Flight Surgeon's attitude during these interviews
should be akin to the equanimity of Osier. Whether
the situation requires five minutes or an hour, convey
the impression that you have nothing more to do than
to listen to him. At the same time there are leads
trickling out of the conversation which may be perti-
nent to the cause of the accident or the "save." These
attitudes and impressions are important in evaluating
the pilot's emotional equilibrium and his ability to
perform under pressure. These are aptly described
as the "Beef and Bones" of the flier's emotional mosaic.
When this informal interview is concluded you
should know whether the pilot is "up" or "down." In
either case inform him so immediately and then pass*
the word to the squadron skipper, preferably in person,
and the ship's captain if at sea. Now you may set up
further conversations if required or merely conduct the
readyroom or wardroom coffee break observation as
necessary. Never convey the idea that you have this
pilot in a test tube for observation; it is entirely un-
necessary. However, do not forget the advantage of a
late evening visit to the pilot's stateroom where he is
surrounded by nothing more than a stack of letters, his
Hi-Fi and a picture of a beautiful woman. This is his
world when not in the cockpit of his aircraft or in the
readyroom and his attitudes here are very often naked
Someone once denned naval aviation as "Prolonged
periods of utter boredom interrupted by moments of
stark terror." Here it is the calling of the Flight Sur-
geon to shorten the sheer boredom and ease the in-
tensity of the stark terror.
U.S. NAVY MEDICAL NEWS LETTER
NURSING SEMINAR ON THE ACUTE CORONARY PATIENT
CDR Martha O. Brandenburg NC USN, Chief of Nursing Service, Station Hospital,
U.S. Naval Air Station, Patuxent River, Maryland.
A Nursing Seminar on the Acute Coronary Patient
in the Hospital sponsored by the Heart Association of
Southern Maryland was hosted by the staff of the Sta-
tion Hospital, Naval Air Station, Patuxent River, Mary-
land, on 9 and 10 December 1964. Attendance was
open to all medical, nursing, and allied medical per-
sonnel interested and involved in whole patient care to
include discharge planning. Approximately 125 persons
attended each day. The patient was presented as seen
by the doctor, hospital staff nurse, dietitian, public
health nurse, vocation rehabilitationist, and the patient
himself. The general theme of the seminar centered
around the real need for the nurse to understand the
experiences of her patient both physiologically and
emotionally and determine accordingly her nursing
activities since the nurse's attitude, manner, and re-
sponse in making nursing judgments influence appre-
ciably the subsequent recovery course of the patient.
During the morning session a review of the physical
changes and medical management of the patient was
presented on 9 December by Dr. Robert T. Singleton,
Assistant Professor of Medicine, University of Mary-
land School of Medicine also Director, Cardiovascular
Laboratory, University Hospital and on 10 December
by Dr. Donald Dembo, Instructor in Medicine, Uni-
versity of Maryland School of Medicine also Chief
of Cardiology, Maryland General Hospital. Both Drs.
Singleton and Dembo stressed the fact that coronary
disease was not necessarily a disease of the aged but
indeed a problem to all adults including in some cases
noted changes in coronary arteries at the early age of
twenty. Dr. Dembo stated that a concept is being
developed and pushed to restore the patient who has
suffered acute myocardial infarction to previous ac-
tivity as quickly as possible inasmuch as those individ-
uals so managed to do better than those who are placed
on restricted activity. The role of the nurse was di-
vided into two areas: (1) the emergency stage at the
time of cardiac arrhythmia, i.e. cardiac arrest or sud-
den death, (2) the healing process.
In the hospital environment the nurse, nurses' aide
or hospital corpsman is very often the first person to
discover the patient experiencing cardiac arrhythmia.
She must initiate immediate action in this sequence:
(1) diagnose, (2) ventilate, (3) cardiac massage,
(4) call for help. Many of the patients experiencing
clinical death can be saved when immediate emergency
measures are started within the first four to six min-
utes prior to the onset of biological death. The im-
mediate emergency need of the patient is ventilation
by mouth to mouth or mouth to nose resuscitation
methods. There is no advantage in stimulating heart-
beat of a patient when there is no oxygenization of
blood. Artificial respiration should be done rapidly
for the first three to six times and repeated inter-
mittently with fifteen seconds of heart stimulation using
closed chest massage. A call must be made for help.
Artificial ventilation must be continued until the pa-
tient assumes spontaneously continuous respiration of
adequate rate and depth. Upon arrival of the Medical
Officer, the Nurse's role quickly changes to providing
supportive care for the definitive cause of arrhythmia.
Appropriate drugs are brought to the bedside, syringes
filled, labeled, and refilled as necessary. All unneces-
sary equipment and personnel should be removed from
the patient environment and a defibrillator and an
electrocardiograph brought to the bedside. Each move-
ment of the nurse must be deliberate and effective
since the demands of the moment leave no time for
clumsiness or awkwardness. Many hospitals have
organized emergency rescue teams that report on call
to the area with appropriate mobile equipment and
drugs; nevertheless, the nurse must be prepared to
bridge the gap between the onset of the illness and the
arrival of the emergency rescue team.
Miss Lucille Kinlein RN, Director of the Cardio-
vascular Disease Nursing Program at Catholic Uni-
versity, gave a paper on Nursing Care of the Patient.
She emphasized the importance of the nurse's role in
her awareness and attitude toward the patient's fear of
death. An atmosphere should be set in which the
patient can feel free to express his anxieties. Actually,
the long-time management begins with the onset. Many
of the earlier reactions of the hospital staff to the pa-
tient's pain, fear, and dyspnea will have a lasting effect
on his response to his illness. Not only can the nurse
keep the doctor informed of the needs, fears and
problems of the patient, she can also assist the patient
to cope with his problems through understanding, in-
terpretation, and support.
During the last hour of each day, a panel composed
of the doctor, hospital nurse, public health nurse,
dietitian, and vocational rehabilitationist discussed
questions presented by the audience.
U.S. NAVY MEDICAL NEWS LETTER
FOUR U.S. NAVY NURSE CORPS OFFICERS
RECEIVE PURPLE HEART AWARDS
ByJ.D. Tikaisky JOC USN
SAIGON, January 8, 1965— Shortly before 6 P.M.
on December 24, Ruth A. Mason entered the lobby of
the Brink Bachelor Officers' Quarters here, where she
paused to talk to her roommate, Frances L. Crumpton,
who had just left Ann D. Reynolds in the suite which
the three U.S. Navy nurses shared on the first floor.
As they talked, an explosion caused by a Viet Cong
Terrorist bomb rocked the building. The blast knocked
Miss Crumpton to the floor, and flying debris struck
Miss Mason and Miss Reynolds. A window frame blew
in on another Navy nurse, Barbara J. Wooster, who
was in her fourth-floor room. The blast ruptured both
of Miss Crumpton's eardrums. Miss Mason received
an injured back, and Miss Reynolds suffered a mild
concussion. All were cut by flying glass.
Moving from patient to patient in the courtyard in
front of the hotel, the four, who are assigned with four
other Navy nurses to the U.S. Navy Headquarters
Support Activity, Saigon, Station Hospital, cleaned
wounds and prepared the injured for evacuation to the
When ambulances and other vehicles began arriving,
the nurses left the scene of the blast and moved with
the first loads of injured to the hospital, where they
refused treatment for themselves and continued to care
for those more seriously wounded.
These four nurses became the first women members
of the U.S. Armed Forces to receive the Purple Heart
Award for injuries in the Viet Nam Conflict.
During the awards ceremony, Headquarters Support
Activity commanding officer CAPT Archie C. Kuntze
USN, cited their actions as "beyond the call of duty"
and "in keeping with the highest traditions of the Naval
"The fact that they were hurt themselves but work-
ing on others had a tremendous morale effect on both
the patients and the hospital staff," said CAPT R. A.
Fisichella USN, senior medical officer.
It was only after all the other 58 Americans and one
Australian who had been injured were cared for that
the nurses permitted doctors to treat their own wounds.
Treating war wounded is an almost daily occurrence
for nurses at the Navy hospital here, which is the only
U.S. Navy medical facility in the world treating com-
bat casualties direct from the field. A special plan to
handle mass casualties is put into effect when large
numbers of persons are wounded in incidents such as
the Brink explosion. The Brink incident was one of
three large explosions which have occurred in Saigon
since the American effort was boosted in 1961.
REPORT ON NEW U.S. NAVAL DENTAL
Mr. Charles A. Greene, Film-TV Production Division,
U.S. Naval Medical School, NNMC, Bethesda, Md.
A new dental training film, "Intraoral Roentgen-
ography," (MN-9774), was released during last sum-
mer and is now being distributed. The purpose of this
23-minute color motion picture is to acquaint dental
personnel with the advantages of variable-kilovoltage
roentgenograph ic equipment and to demonstrate that
the technique using parallel film placement and fixed
exposure time with varying kilovoltages produces intra-
oral roentgenograms of superior quality.
An article in the 7 August issue of the News Letter
(Vol. 44, No. 3, Dental Section) described in some
detail the technique of parallel film placement and use
of the extended tube or "long cone", and suggested
KV settings for specific oral areas. The new training
film will serve as a graphic demonstration of the prin-
To establish a background against which to describe
the use of improved equipment and techniques, the
film first explains the principles of roentgen-ray gener-
ation and shows some characteristics of the ray. It
emphasizes control of radiation exposure by means
of filtration, use of fast film and the increase of dis-
tance. These sequences are in excellent animation that
presents the principles so clearly that the statement
will appeal to both the new learner and the experienced
A comparison of the angle-bisection technique with
that employing parallel placement of the roentgeno-
graph^ film is also presented in animation. Live-action
sequences follow, showing precisely how the parallel-
placement technique works in various areas of the
mouth, in combination with right-angle positioning of
the "long cone". The film explains the use of increased
kilovoltage for optimum penetration, control of radia-
tion exposure and improvement of image quality.
Roentgenographic films of actual cases are of course
included to show the results of the improved techniques
described, as compared with results of those formerly
Prints of "Intraoral Roentgenography" are being
distributed to all naval hospitals in the United States
and to certain specialized facilities for training of
ADDENDUM TO ARTICLE ON USNH,
PHILADELPHIA, DESCRIBING THE U.S.
NAVAL AURAL REHABILITATION CENTER
The article in the November 27th issue of Medical
News Letter concerning the U.S. Naval Aural Re-
U.S. NAVY MEDICAL NEWS LETTER
habilitation Center was prepared by Mr. Joseph Scan-
Ion, Director of the Aural Rehabilitation Center, under
the supervision of Commander G. R. Hart, Chief of
Department of Otolaryngology. Further reference
material regarding the work of this Center may be
found in the following sources: 1. "The Rehabilitation
Program of the Navy: Aural Casualties", Laryngo-
scope page 489, Sept 1944. 2. "Rehabilitations of
Hearing and Speech." U.S. Naval Medical Bulletin,
March 1946."— Editor
CAT SCRATCH DISEASE
A Report on the Experiences of CAPT A. M. Margileth,
Chief of Pediatric Service, USNH, Bethesda, Md.
NEW YORK — Skin test antigen has proven to be a
useful differential diagnostic tool in cat scratch dis-
ease. According to CAPT A. M. Margileth of a U.S.
Navy Pediatric Service, the antigen can be used with,
at the very least, "95% confidence."
In a report to the annual meeting of the American
Academy of Pediatrics, the naval pediatrician detailed
his experience with 41 young patients (most under 20
years of age) over the past seven years.
When the skin test antigen was used in the 41 cases
studied at the U.S. Naval Hospitals in Chelsea, Mass.,
and Bethesda, Md., all patients had a positive reaction
which correlated well with the clinical diagnosis. Other
studies have shown only 3% to 4% positive reactions
in control (well child) groups. No false positive skin
tests were observed in over 60 patients with tubercu-
losis, infectious mononucleosis, tularemia, brucellosis
and Hodgkin's disease and bacterial lymphadenitis.
It was noted that while lymphogranuloma venereum,
syphilis and toxoplasmosis are rarely encountered in
young children, they should also be considered when
marking a differential diagnosis.
Most of the cat scratch disease patients exhibited
the usual features — a primary lesion followed by fever,
malaise and subacute regional adenitis, with gradual
resolution in one to two months. Several of the
Bethesda pediatrician's cases had unusual manifesta-
tions, for example, atypical pneumonia, encephalitis,
popliteal space tumor or the oculoglandular form of
CAPT Margileth also confirmed the findings of
others that the disease occurs more frequently during
the fall and winter months and that it infects children
and teenagers much more often than adults. "It is
usually transmitted by a scratch or lick of a cat, but
in rare instances, dogs have been implicated," he said.
"The disease is not transmitted from man to man, so
neither isolation nor quarantine is indicated."
The Bethesda pediatrician noted that his repeated
attempts to isolate the causative agent were unsuccess-
ful, as they have been in other studies, though it is
presumed to be a virus.
"Management of the patients was directed first
toward the primary lesion if present," CAPT Margileth
said. "Moist compresses which promoted drainage
appeared to shorten the duration of the regional lym-
In some of the cases, the naval pediatrician per-
formed excisional biopsy of the primary lesion or a
regional bubo. He found that if suppuration of the
bubo occurred, repeated aspiration using local anes-
thesia was the most effective and least traumatic
"Closed aspiration is simple, can be performed
quickly in the office, and provides material for culture
and preparation for more antigen," he explained.
"Antibiotics are ineffective and were used only for
secondary bacterial complications, which were rarely
CAPT Margileth noted that the prognosis was ex-
cellent for all of his patients. There were no sequelae,
and second attacks did not occur.
PEDIATRIC OFFICE BACTERIOLOGY*
CAPT Andrew M. Margileth MC USN, Chief of
Pediatric Service, U.S. Naval Hospital, NNMC,
Streptococcal infections have been largely controlled
with proper recognition and therapy. The serious and
long lasting sequelae that were formerly seen are
relatively rare. It must be granted that all infections
cannot be cured even when properly treated by present
methods, but results will only be good in those cases
that are amenable to therapy when the disease proc-
esses are properly recognized. This recognition of in-
fection is not, however, as simple as generally believed.
Many clinicians state that it is easy to recognize
streptococcal pharyngitis, but this is not always true.
Improper diagnoses have been reported 25 to 65 per
cent of the time and then generally too much, too
little, or inappropriate therapy has been instituted.
Our answer to this confusion is the utilization of
culture facilities in the pediatric outpatient clinic.
Rather than send the patient to a laboratory, we take
the cultures, incubate them for 18 to 24 hours, and
* Adapted, in part, from Proceedings of the Monthly Staff Confer-
ences, USNH, Bethesda, Maryland, 15 Nov 1963; also. Guest Edi-
torial, Medical Tribune.
U.S. NAVY MEDICAL NEWS LETTER
then read them. In doubtful situations we check for
beta hemolysis with a microscope and do gram stains.
This is an office aid to diagnosis which is relatively
inexpensive, and simple to perform in a clinical prac-
tice of 100 patients each day.
Some of our colleagues practicing medicine will
admit that diagnosis of what is and what is not strep-
tococcal infection is sometimes difficult, but they object
to the routine use of cultures for the following reasons:
(1) Delay in reporting: the average clinical laboratory
will return results in 3 to 5 days, a time lag which is
difficult to overcome. We have our report in 24 to 48
hours. (2) Cost: the high cost of culture plates,
media and throat swabs ($5 to $15). Our costs have
averaged $1.00 per patient. (3) Time: many physi-
cians feel that they cannot take time to explain to the
patient or the family the necessity for a culture when
an antibiotic will probably be given anyway. (4) Cum-
bersome: many physicians state that fluorescent anti-
body techniques will be available in the near future
and then therapy can be instituted quickly and ac-
curately as indicated. Although it is true that these
techniques are just as accurate and results are available
sooner, they must be performed in a standard labora-
tory, and such facilities generally are not available to
These objections are valid; however, they can be
overcome with the use of a small incubator in the
office, and commercially prepared blood plates, and a
few minutes to read the plates each morning. The
patients' case histories can be reviewed as each plate
is examined. In this way, the delay of the report and
the time factor can be minimized. Cost is also reduced
for the patient. The initial financial outlay for the
necessary equipment is reasonable and in terms of
patient interest and appreciation (not to mention the
cost of 5 to 10 days of antibiotic treatment which may
be unnecessary) the original investment will be quickly
In spite of a busy schedule with large numbers of
patients, we have had a rewarding experience with
culture facilities in our clinic. We have a large group
of physicians in training who come from many disci-
plines and teaching experiences. All of us gain knowl-
edge with the correlation of the clinical and bacterio-
logic diagnoses. This, we feel, is medical education;
but also is a type of education that carries' over to
the parent. We have found it easy to convince people
that it is important to delay therapy in order to develop
antibody response. The opportunity to determine ap-
propriate antibiotic therapy in those patients that do
have a specific bacterial infection is most valuable. In
the long run, we are able to save extra cost to the
patients that are not overtreated with antibiotics. It is
not an unusual situation now, to have parents ask for
a culture instead of an antibiotic.
Ever since the Second World War the need has been felt for a code of ethics concerning experiments carried out
on human beings in the name of medicine. After an intensive examination of the subject extending over several
years, such a code has now been adopted by the World Medical Association. — WHO Chronicle 19(1): 31,
The legal measures on radiation protection introduced in a number of countries in recent years have tended to
concentrate on the hazards arising from the various uses of nuclear energy. Yet x-rays — which are often not even
mentioned in the legislation — at present constitute by far the greatest msn-made source of radiation exposure.
—WHO Chronicle 19(1): 34, January 1965.
"Much of our citizenry takes seapower for granted, never surprised when Navy ships turn up in various hot-
spots around the world. I hope our Naval presence will always be available, but I emphasize that seapower is so
important to our nation that it must never be neglected or underestimated. There is an immense penalty attached
to failure to understand the use of the sea and the need to control it."
Admiral David L, McDonald
It is becoming increasingly clear that the control of gonorrhoea is unlikely to be achieved except by mass treat-
ment or by some type of immunoprophylaxis. The recent development of trial vaccines against cerebrospinal
meningitis may help to advance research on the immunology of gonorrhoea, since the agents of both diseases
belong on the Neisseriae group and are crossreactive serologically. — WHO Chronicle 19(1): 9, January 1965.
U.S. NAVY MEDICAL NEWS LETTER
ELECTRIC "BARRIERS" FOR SNAIL CONTROL
The National Cancer Institute, Public Health Service,
and the National Aeronautics and Space Administration
are cooperating in a 1-year medical research project to
study the anticancer, carcinogenic, and antiradiation
potentials of a group of chemicals closely related to
plant growth regulators.
The study extends earlier NASA research that
showed that certain plant growth regulators which pro-
long the life of cancer cells in a test tube can produce
a lethal effect when altered. Mixtures of the regulators
and their related compounds were even more lethal.
The effects of a variety of these compounds on tumor
cells in test tubes and in laboratory animals and on
the survival of irradiated normal and tumor-bearing
mice are being investigated.
The research is being conducted in the Space and
Information Systems Division of North American
Aviation, Downey, Calif., under a $198,185 contract
with the Public Health Service. The National Cancer
Institute is providing technical direction for the project,
which is being financed through a transfer of funds to
the Public Health Service by NASA under its tech-
nology utilization program. — Public Health Reports
79(12): 1080, December 1964.
Further investigations into an electrical "barrier"
system, which might be useful in the control of aquatic
snails are recommended in the fourteenth report of
the WHO Expert Committee on Insecticides.
It has been observed that when an electric current is
passed through water where aquatic snails are sub-
merged, they move rapidly towards one of the elec-
trodes. This phenomenon, it is felt, might be put to
good account as a control measure against bilharziasis
by preventing, for example, the migration of snails
past given points in a stream system.
The Committee also draws attention to the possibility
of applying molluscicides to rivers and ponds by placing
the chemical in a porous-walled container, from which
it would slowly escape by diffusion. This is similar in
principle to the old method of suspending burlap bags
of copper sulfate in the flow, but the use of a porous-
walled container might permit a more constant flow
of molluscicide as particle size would no longer play
a part. The attraction of the method lies in its extreme
simplicity and in the fact that the containers can be
left completely submerged, thus minimizing the chance
of their being tampered with while unattended. — WHO
Chronicle 18(11): 431, November 1964.
Some drugs appear to have a prophylactic action against smallpox and may prove to be of considerable help in
the control of the disease. But their action is short-lived, so that the population in endemic areas would still have
to be vaccinated and revaccinated periodically. — WHO Chronicle 18(11); November 1964.
DEPARTMENT OF THE NAVY
U. S. NAVAL MEDICAL SCHOOL
NATIONAL NAVAL MEDICAL CENTER
BETHESDA. MARYLAND 20014
PERMIT NO. 1048
POSTAGE AND FEES PAID
U.S. NAVY MEDICAL NEWS LETTER